20041005.pdfDATERECEIVED//
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS
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Wir : - I�
MAILING ADDRESS
CITY zip TELEPHONE
NAME
2
ADDRESS
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CITY ZIP TELEPHUNL
NAME CBL#
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ADDRESS
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATIO I DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
0
NEW
RESIDENTIAL
PLUMBING it MECH
COMMERCIAL
COMPLIANCE OR
ADDITION
0
MIXED USE
CHANGE OF USE
REMODEL
1:1
MULTIFAMILY
SIGN
El
REPAIR
0
GRADING
CYOS
Ei
FENCE
( — x F1)
DEMOLISH
1:1
TANK
OTHER
GARAGE
CARPORT
Ej
RETAINING WALL
ROCKERY
ED
/FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
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LOT NO
LID NO
LID FEE S
"1 171
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T1,5 Apriro�od
RW Pernia Requvcl
Street use Permit Rvuuiied.
E3
EXISTING PROPOSED
Inspechon Requited
0
Siau*x� Required
0
REQUIRED DEDICATION FT
Underground
W.11110 requited
13
13
METER SIZE LINE SIZE NO, OF FIXTURES I PRV REQUIRED
I I YES 0 NO 13
REMARKS
OWNERtC.ONTRACTOR RESPONSIBLE FOR EROSIPN CONT
ENGINEERING REVIEWED BY
DATE
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INSPECTION
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C3 YES 13 NO
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CAP
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SIGN AREA
HEIGHT
WAI�ER 13
V
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ALLOWED PRO SED
ALLOWED PROPOSED
STUDY 13
LOTCOVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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PLANNING
PARKING
LOTAREA �
REVIEWED BY DATE
PROVIDED
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
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NUMBER NUMBER OF
OF DWELLING
qT171PIPR UNITS I
REMARKS
TYPE OF CONSTRUCTION
SPECIAL INSPECTION CONSULTANT
REQUIRED 13YES I
OCCUPANT
GROUP .7/
OCCUPANT
LOAD
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REMARKS
GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
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VALUATION
$ 00
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Description
FEE
Description
FEE
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Lout CAP I f
Plan Check
;?3
State Surcharge
HEATSOURCE LOTSLOPE% VESTEDPATE
IV;+ -,VA IVA
Building Permit
;?, 7, 1�'
city surcharge
PLAN CHECK NO,
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
Grading
Engr. Review
SEPARATE PERMISSION.
0 PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
I
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESSORS Fire Review
Plan Chk. Deposit
u IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF -
j Fire Inspection Receipt #
E EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
r ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY -50
I
C FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due 7
3 Y CITY ORDINANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF AN
-1
3 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
1
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thit. application is not a permit until signed by the
Building Official or hisiher Deputy and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
receipt is acknowledged in space provided
FOR INSPECTION -
IN VIOLATION
WORKMEN'S COMPENSATION_LU5UR.ANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
SIGNATURE R G NT): DATE S
(425)
2
L(OWNER
LNED 1 1.
771-0220
7-E�
RELE< Y DATE
ATTENTION
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.
PINK - OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU
ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO: 1—Y1,4411
DATE:
---ffMLDING DIVISION
MEMO TO: PE
FROM: FIRE DEPARTMENT DATE
I;rLA% 7N ENGINEERING DIVISION DATE z
PLEASCSIGN 0
PLANNING DIVISION DATE— 0
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PLEASLSIGN
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PROJEC 7 U5
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PERMIT ADB# DATE INSPECTED 6- /C"-�
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with - approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of: &&--
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-*GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
FAMED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRE CTION NOTICE given to owner/contractor by inpector
I
2.
3.
RE-INSP ECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:forms:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION,
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor insulation .........
Wall Insulation ...........
Ceiling insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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